Abstract:

Background: Neonatal sepsis is a significant cause of morbidity and mortality in neonates’ worldwide. Appropriate clinical diagnosis and empirical treatment in a given setting is crucial as bacterial pathogens and antimicrobial susceptibility pattern can considerably vary in different settings. Therefore this study was conducted at Bugando Medical Centre (BMC), Tanzania to determine the prevalence of bacterial neonatal sepsis, common microbial isolates, the susceptibility pattern and predictors of positive blood culture and death thus providing essential information to formulate a policy for management of neonatal sepsis.

Methodology: This was a prospective cross sectional study with follow up component involving 300 neonates admitted at BMC neonatal unit between March and November 2009. A Standard data collection form was used to collect all demographic data, clinical symptoms and signs of neonates. Blood culture was done on Brain Heart Infusion broth followed by identification of isolates using conventional methods and testing for their susceptibility to antimicrobial agents using the disc diffusion method.

Results: Among 770 neonates admitted during study period; 300 (38.9%) neonates were diagnosed to have neonatal sepsis by World Health Organization (WHO) criteria. Of 300 neonates with clinical neonatal sepsis 121 (40%) and 179 (60%) had early and late onset sepsis respectively. Positive blood culture was found in 149 (49.6%) of which 57(38.3%) were from neonates with early onset sepsis and 92(61.7%) from those with late onset sepsis. The most common isolated pathogens were Klebsiella pneumonia, Escherichia coli and Staphylococcus aureus. Most of gram negatives pathogens were highly resistant to commonly used antibiotics in the unit and they were uniformly susceptible to ciprofloxacin and meropenem. Majority of staphylococci were resistant to penicillin and they were all sensitive to vacomycin. Predictors of positive blood culture in early and late neonatal sepsis were inability to feed (p=0.0001), lethargy (p=0.0001), convulsion (p=0.003) and place of delivery (p=0.003). Deaths occurred in 57 (19%) of neonates. Factors that predicted deaths were positive blood culture (p=0.0001), gram negative sepsis (p=0.0001) and infection with ESBL (p=0.008) and MRSA (p=0.008) isolates. Higher mortality was observed in neonates with early onset disease.

Conclusion: The prevalence of bacteria neonatal sepsis was 49% in our setting Klebsiella pneumonie, Escherichia coli and Staphylococcus aureus are leading causes of neonatal sepsis in our setting; majority of these isolates are multiply resistant to ampicillin and gentamicin. Mortality and morbidity on neonatal sepsis is high at our setting and is significantly contributed by positive blood culture with multi-resistant gram negative bacteria.

Recommendation: Guidelines for management of neonatal sepsis at BMC are needed so that morbidity and mortality of sepsis due to highly prevalent multi-resistant gram negative bacteria and MRSA can be reduced.